For hospitals and physicians to thrive in evolving healthcare environment they must put aside their historic adversarial relationships in favor of defining and leverageing areas of common interest.

1. Overcoming the barriers to Hospital – physician collaborations in creating healthcare innovation Accidental Adversaries © 2011 Karen Wade, Ph.D.

2. Accidental Adversaries* Definition: When groups of people who ought to be in partnership with one another and have much to gain by partnering, end up bitterly opposed. Solution: Potential partners strengthen understanding of one another’s needs, how they unintentionally undermine one another, and how they can support each other, instead. Classic Example: Procter & Gamble and Wal-Mart *Senge et al (1994), The Fifth Discipline Fieldbook © 2011 Karen Wade, Ph.D.

3. Adversarial Dynamics Hospital Executives and Physicians Exceptionally different professional cultures and development pathways create values collisions Each group controls the other’s vital resources Transactional vs. Authentic Relationships Task focus on business plan/financial structures Lack of trust = cautious transactions that suppress creativity Lack of trust = impaired conflict resolution skills Ineffective conflict resolution = suboptimal/failed ventures © 2011 Karen Wade, Ph.D.

4. The Innovation Imperative Lessons from the Auto Industry Meltdown ….The combination of very un-innovative business plans, visionless management, and overly generous labor contracts….instead of focusing on making money around innovating on fuel efficiency, productivity, and design, GM threw way too much energy into lobbying and maneuvering to protect its gas guzzlers. Thomas Friedman, NY Times November 11, 2008 It is incumbent upon hospitals and physicians to cease protecting the status quo, and to envision and implement new ways of making money by delivering value to their customers in re-imagined and responsive services, professional relationships, and revenue models …OR FACE A SIMILAR FATE! Nate Kaufman (paraphrase) Kaufman Strategic Advisors Article, January 2009 © 2011 Karen Wade, Ph.D.

5. From Adversaries to Allies: The Context Environment is ripe as never before Mutual survival needs are strong motivators Proposed new reimbursement models threaten viability of many hospitals and medical practices EHR/technology mandates are too expensive for many physicians Individual portfolio losses creating unprecedented financial and emotional stress among physicians Largest proportion on record of physicians who want to leave medicine; hospitals need the revenue they produce; must retain Some predict a flood of physicians newly interested in employment Movement toward ‘clinical integration’ of business/clinical outcomes Must move beyond historic mistrust to creative shared action – or PERISH © 2011 Karen Wade, Ph.D.

6. ‘Simple’ Rules for Making New Alliances Work Focus more on the ‘how’ of working together vs. the ‘what’ Monitor alliance progress via process & outcome metrics Leverage differences to create value Encourage relationships beyond formal structures Conscientiously manage internal stakeholders J. Hughes and J. Weiss, November 2007 Harvard Business Review © 2011 Karen Wade, Ph.D.

7. © 2011 Karen Wade, Ph.D. Simple ≠ Easy

8. Prototype ‘Intensive Care’ for New Alliances Process to overcome historic lack of collaboration and/or adversarial dynamics: Assess Collaborative Potential & Innovation “Readiness” Design “Treatment” Recommendations to Enhance Success Apply “Treatment” and Support Alliance Development Assess Effectiveness of “Treatment” © 2011 Karen Wade, Ph.D.

9. Phase 1a: Assess Collaborative Potential Design/execute triangulated methodology, involving broad base of stakeholders, to determine: Is there, and what is, the ‘burning platform’ that is motivating the collaboration at this time? Do the key players view the burning platform the same way, and with the same degree of ‘heat’? What potential drivers vs. obstacles exist to a productive alliance and/or its outcomes? What prior experiences have we learned from? Leadership: who has the ‘right stuff’, on both sides, to engage over the long-term, through the challenges? © 2011 Karen Wade, Ph.D.

10. Phase1b: Share Findings and Recommendations Key Finding Is there sufficient readiness and motivation to collaborate for innovation at this time with a high likelihood of success? Key Recommendations If yes, who is most likely to gel into the core ‘alliance team’ and what processes and considerations would facilitate their success? If no, what needs to happen within the system of stakeholders to arrive at readiness? © 2011 Karen Wade, Ph.D.

11. Phase 2: Design Adversaries to Allies ‘Treatment” Based on assessment findings, customized program components build: Positive leadership impact, individually and collectively Team identity, interpersonal trust, effective communication Alignment around ‘rules of the road’ going forward Vision What does success look like 2 to 3 years from now, 5 years out? Success regarding services, revenue, and relationships Innovation and change management knowledge © 2011 Karen Wade, Ph.D.

13. Early Stage (Months 3 to 12)

14. Assist in preparation of meeting agendas and prepare leadership for managing meeting dynamics

15. Monitor process benchmarks as indicators of alliance success

16. Be present at and provide group coaching during first several meetings, especially in conflict resolution

17. Graduate to the background with increasing group competence

18. Ongoing Support (Months 13 to 24)

19. Based on consensus, continue to support the alliance as needed with periodic observations as a ‘reality check’ © 2011 Karen Wade, Ph.D.

20. Phase 4: Evaluate Alliance Progress This phase co-occurs with the launch of the alliance. Periodic metrics provide feedback for continuosly improving: Relationships Leadership Effectiveness Productivity (achieving innovation goals) Other, as identified © 2011 Karen Wade, Ph.D.

21. Expected Outcomes of Strong Alliances Innovation that is responsive to customer/community need High quality/efficiency (streamlined processes) Increases in clients to hospitals and to medical practices Increases in revenue/profitability for hospitals and medical practices Alignment of clinical and business outcomes Enhanced quality of life for physicians Strengthened institutional capital and communities A team that will want to ‘do it again’ © 2011 Karen Wade, Ph.D.

22. Why Use Management Psychologists? Uniquely qualified to assess the feasibility of and to provide ‘intensive care’ to early stage alliances: Doctoral training in human/systems behavior with real-world applications Part of professional/scientific culture Expert advisors to business leaders Experts at harmonizing between ‘business’ minds and ‘clinical/technical/scientific’ minds. © 2011 Karen Wade, Ph.D.